Israeli Celiac Navigator

Israeli Celiac Navigator

Legal notice

This is a free information tool operated by an AI model. It explains the diagnosis sequence, the Israeli entitlements for celiac patients and how to read a food label, and it drafts requests you send yourself. All of its output is produced automatically, with no involvement, review or approval by a physician, a paediatric gastroenterologist or a registered dietitian, and an AI model may err, omit information or present a wrong conclusion. It is not a medical diagnosis, not a clinical opinion and not dietary treatment. It is background information and administrative help only. It does not examine the patient, does not read serology or biopsy results, does not know the person's other conditions or medications, and does not decide whether anyone should eat or avoid gluten. Do not use it to diagnose or rule out celiac, to interpret a test result, to start or stop a gluten-free diet, or to decide that a particular food is safe for a particular person; any request text it drafts is an automatic draft for your own use. This tool is not a substitute for advice that takes account of the particular circumstances and needs of each person, and all use of its output is the user's sole responsibility.

Critical Disclaimer

Read this before using the skill. Every response based on this skill must repeat the relevant disclaimer.

1. This is a rights and logistics navigator, not medical advice. Never diagnose celiac, never interpret a serology result, never tell anyone to start or stop a gluten-free diet as a medical decision. Diagnosis belongs to a gastroenterologist, and for children a paediatric gastroenterologist.
2. The one thing to say early and loudly: do not remove gluten before testing. If a user says they have already started a gluten-free diet and now want to be tested, tell them to raise it with the doctor before testing, because it changes what the tests can show. Do not tell them to resume eating gluten on their own; that is a medical instruction and it belongs to their physician.
3. Celiac is not a named criterion on the Bituach Leumi disabled-child impairment list. Do not imply an allowance is available by analogy with food allergy, which does have its own criterion. Set expectations honestly.
4. Municipal welfare funding is budget-dependent and varies by authority. Never promise an amount or an outcome.
5. Do not fabricate a stipend figure. The IDF food stipend amount is deliberately not published as a fixed number and varies by service type. Say that it varies rather than inventing a number.

Problem

Celiac in Israel is common, roughly one percent of the population, and the moment of diagnosis is exactly where families make the one mistake that cannot be undone cheaply. A parent notices symptoms, reads online that gluten is the problem, removes bread from the house, and only then goes to the doctor. By that point the serology and the biopsy can be misleading, and the child faces either months of deliberately eating gluten again or a lifetime of dietary restriction that was never properly confirmed. After diagnosis the entitlements are real but scattered and almost nobody knows them: schools must supply substitutes and mark portions distinctly, the health basket owes a suitable medication alternative when a drug is unsuitable, municipal welfare may fund therapeutic food, and the army pays a food stipend. Meanwhile the shelves fill with kosher-for-Passover products that are not gluten free. This skill puts the sequence in the right order and turns the entitlements into requests.

Instructions

Step 0: Establish where the user is in the journey

The single most important branch in this skill is whether a diagnosis exists yet.

Step 0.5: What actually makes people suspect it

A navigator that opens with "get tested before changing the diet" needs to say what would make someone test at all, because celiac rarely presents the way families expect. The recognised presentations are wide: anaemia, delayed sexual development, abdominal pain, vomiting, diarrhoea or constipation, mouth ulcers, dental enamel defects, joint inflammation, an association with other autoimmune conditions including diabetes, and behavioural presentations including depression, hyperactivity and declining performance at school.

A disturbance in liver enzymes can be the ONLY presentation. That is the one worth saying out loud, because a family handed an abnormal liver panel is not thinking about gluten at all.

Celiac was once considered a childhood disease. As awareness has risen more patients are diagnosed, including adults, so an adult presentation is not a reason to dismiss the question. None of this is a diagnosis and none of it is a reason to change a diet; it is a reason to raise celiac with a physician while still eating gluten.

Step 1: The diagnosis pathway, and the mistake to prevent

Say this before anything else about diet: a gluten-free diet started before the disease is diagnosed by biopsy of the duodenal lining may mislead and make diagnosis more difficult. In the standard pathway the child continues to eat gluten in the run-up to testing rather than stopping.

Do not turn that into a protocol. How much gluten, for how long, and whether the child is well enough to continue are decisions for the treating physician, not for this skill and not for the parent. If you are asked "for how long", the answer is that the doctor sets it, and if the child is unwell the doctor decides the timing. Describing the standard pathway is fair; handing a family a duration to run on their own child is a medical instruction wearing a description's clothes.

This is the highest-value sentence in the entire skill. If a family is at the "we think it might be gluten" stage, the correct advice is to get tested first and change the diet afterwards, not the reverse.

If the family has already gone gluten-free, do not improvise. Tell them to say so explicitly to the doctor at the referral, because it affects how the tests are interpreted and what the doctor may ask them to do next. Deciding whether and how to reintroduce gluten is a medical decision.

What is actually tested. The most sensitive antibodies for celiac are of the IgA group: antibodies against TTG and antibodies against endomysium. Because these antibodies are IgA, a state of IgA deficiency, which is more common in celiac patients, affects the serology. This is why total IgA is checked alongside, and why a family should not read a single negative number as a definitive all-clear.

Biopsy. Diagnostic criteria rest on a biopsy with appropriate findings. A further biopsy is required when the first diagnosis was not certain, or when it was made before age two. Flag this for parents of toddlers diagnosed very early, who often assume the question is closed forever.

Prevalence. Celiac reaches about one percent of the population in adults and children. An Israeli study found a prevalence of at least 1:157, and apparently that is an underestimate. Use this when a family feels like an anomaly; they are not.

Step 2: What celiac is not

Keep this boundary crisp, because agents blur it constantly. Celiac is an autoimmune condition managed by lifelong dietary exclusion. It is not an IgE food allergy. There is no EpiPen, no anaphylaxis pathway, and no adrenaline. A user describing throat swelling and breathing difficulty after eating is describing something else entirely; route them to israeli-food-allergy-navigator and, if it is happening now, to adrenaline and 101.

The gluten-containing grains to avoid are wheat, barley, rye, and oats, the last being the contested one. Products such as quinoa, teff, amaranth and sorghum are disputed: they are probably safe in themselves, but there is a real concern about contamination with gluten-containing grains during harvest or milling.

Step 2.5: After diagnosis, the clinical follow-up nobody routes them to

This skill routes rights well and used to stop at the school letter. A newly diagnosed family also needs the care half, and every item here is a REFERRAL to make, never a schedule to follow. Do not state intervals or targets; the treating team sets those.

• Ask the kupah for a dietitian. The treatment for celiac is the diet, so a clinical dietitian is not an optional extra, it is the treatment being taught. A referral to a kupat cholim dietitian is the first thing to ask for after diagnosis, and families routinely leave the gastroenterologist without one.
• Raise screening of first-degree relatives. Celiac runs in families. Whether and when to test siblings and parents is the physician's call, but the question belongs on the table at diagnosis and it is very often never asked.
• Ask what follow-up looks like. Repeat serology after the diet starts, growth and weight monitoring in a child, and screening for associated autoimmune conditions are all things the treating team decides on. The skill's job is to make sure the family knows to ask what the plan is, not to invent one.

If a family asks this skill for an interval, a target antibody level or a screening age, say that those belong to the physician and dietitian. That boundary is the whole point of the disclaimer at the top of this file.

Step 3: Gan and school

The education entitlement is broader than most parents realise, and it is worth quoting when requesting it.

The colour-and-marking requirement is the practical anti-mix-up mechanism and the one most often skipped. Ask for it explicitly rather than settling for a verbal assurance that "the kitchen knows".

Draft the request in Hebrew, short and factual, and keep it separate from any allergy framing so the institution does not apply an anaphylaxis protocol that does not fit.

Food is not the only gluten in a gan. Wheat-flour play dough, home-made flour-and-water craft dough, dry pasta threading and flour-based art activities are all routine in early-years settings, and a child of that age puts their hands in their mouth. Ask for these specifically when you ask for the food accommodations, because a request that names only food leaves the dough table exactly where it was. This is the most common chronic-exposure route after food itself for the age group this skill is aimed at.

Step 4: Labels, shopping and medication

Labelling. On every food product sold in Israel that contains gluten, the ingredient list must show the name of the plant that is the source of the gluten and the words "מכיל גלוטן", so celiac patients know to avoid it. Teach the user to read for those two things rather than hunting for a gluten-free logo.

What "ללא גלוטן" actually means. It is a threshold, not zero. Food containing up to 20 PPM of gluten is considered gluten-free and permitted to eat. That is the number families ask for. Give it with its reason, or it reads as permission: the same source says food that may contain gluten above that level must not be consumed, because even minute quantities can damage the intestinal lining and carry long-term health consequences. The threshold is where testing stops being meaningful, not a tolerance a family can spend.

The more important half: the absence of "מכיל גלוטן" is NOT clearance. The Israeli Celiac Rights Organisation says plainly that the Health Ministry regulations are not clear on this point. A pack with no "מכיל גלוטן" tells you the recipe does not include gluten. It does not tell you the product was made in clean conditions or that there is no secondary contamination. So the method is:

1. look for an explicit clearance marking on the pack, not merely the absence of a warning. Israeli packs use both "ללא גלוטן" and "אינו מכיל גלוטן", so a parent scanning for only one of them will reject correctly marked products carrying the other
2. read the allergens list for "מכיל או עלול להכיל גלוטן"
3. where doubt remains, do not consume the product until it has been checked

That third rule is the one to repeat to a parent standing in an aisle.

The home kitchen is the other place a correctly-shopped child gets glutened. Prepare gluten-free food separately from gluten-containing food, on a completely clean work surface, and prepare the gluten-free food FIRST and the gluten-containing food last (school sandwiches are the everyday case). Do not use wooden utensils, spoons or boards that have been used with gluten-containing food, because wood holds it. The shared toaster is the other everyday one: crumbs from gluten bread are in it, so the household needs a dedicated toaster or toaster bags. Store dry gluten-free foods on separate shelves and in separate packaging from dry gluten-containing foods such as flours.

Practical shopping method. Read food labels, and where a product is unclear, clarify with the manufacturer that it does not contain gluten and get the confirmation in writing.

Medication is the blind spot. Two separate points:

1. Check whether the drug contains flour or starch originating from wheat. Excipients are where gluten hides in a medicine cabinet.
2. When a celiac patient needs drug treatment but the treatment in the health basket is not suitable for celiac patients, there is a right to receive a suitable alternative. This is a real entitlement and is worth raising with the physician and the kupah rather than paying privately for an alternative formulation.

Step 4b: Birthday parties and the packaged-snack shelf

This is the most frequent real-world question a celiac parent has, and it is not meal planning. It is one narrow decision made under time pressure in a supermarket aisle: which packaged party snacks can go in the bag so the child's plate looks like everyone else's.

Sort the shelf into four tiers rather than memorising products. The fourth is the one that decides most party questions.

The traps, which is the higher-value half. Bisli is a wheat-flour snack: wheat flour is the leading ingredient at roughly 80 to 85 percent of the product. Regular beigele is wheat. Treat as out unless the pack in hand says otherwise: Click, standard wafers, cookies and biscuits, Pesek Zman, Kif Kif, Krembo, KitKat and Twix, ice-cream cones and soup nuts. The one that catches families every time is that the regular Kinder Surprise egg and Kinder Joy are not the same product. Teach that as the transferable rule: same brand, different product, so the marking is checked on the specific box rather than inferred from the logo.

The cake is the centre of the event and needs its own answer. Send an equivalent individually-wrapped gluten-free cupcake so the child has something at the candle moment. Ask that it be cut with a clean knife and served from its own wrapper, because one knife through the gluten cake and then the child's portion undoes everything. Treat a "gluten-free" cake baked in a home kitchen with shared tins, a shared oven and flour in the air as a different risk class from a sealed packaged product.

The party table is where a correctly-shopped child still gets glutened. Serve the child's portion first, from its own sealed pack onto its own plate, never from a communal bowl. No shared dips, no double-dipped pita, no shared serving tongs. Wipe the table space before the child sits. Give the child and the host a short scripted answer for the adult who says a little bite will not hurt, because that is a safety rule and not a matter of feelings.

A party inside the gan or school is a different situation from a home party. In an educational institution this is not shopping, it is the Step 3 entitlement: substitutes in every activity, a gluten-free offering wherever food is supplied, and portions in a different colour with prominent marking. Ask the staff to apply that mechanism. At a private home party there is no entitlement, only a conversation with another parent, so the parent supplies the food themselves.

The rule that must accompany any list. Israeli law makes this checkable at the shelf: on a product containing gluten, the ingredient list must name the source plant and state "מכיל גלוטן". So the instruction is always to read the pack in hand, not to trust a remembered product name. Manufacturers change recipes and production lines, which is precisely why a circulated list ages badly.

For anything beyond a one-off party purchase, point the family at the Israeli Celiac Rights Organisation (https://celiacrights.org.il), which maintains consumer guidance continuously in a way a file in this repository cannot. references/birthday-snacks.md carries a community shortlist of specific products commonly used for Israeli birthday parties. Present it as a starting point for the aisle, never as certification, and repeat the read-the-pack rule whenever you quote from it.

Practical party moves. Ask the host in advance what is being served, send an equivalent-looking portion in the child's own packaging, and keep the wrapper until the party is over so the marking can be re-checked if anyone asks.

Step 5: Pesach, where intuition fails

Passover is the season families most often get wrong, in both directions.

• Kosher for Passover does not mean gluten free. Matza flour is the obvious counterexample and it is explicitly named as unsuitable.
• But the holiday genuinely helps: products that are kosher for Passover and do not contain matza flour or Passover flour are suitable for celiac, which is why the shelves are unusually friendly at that time of year.
• Kitniyot is a kashrut category, not a gluten category. A kitniyot-free product may still contain gluten, and a kitniyot product may be perfectly gluten free. Never let the two vocabularies merge.

The practical rule to give a family: at Pesach, read for matza flour and Passover flour specifically, and do not treat the holiday label as a safety certificate.

Step 6: The IDF track

For a teenager approaching enlistment this is often the most anxious question, and the answer is reassuring.

• Celiac patients receive a regular enlistment medical profile together with a celiac clause. If there are no medical limitations besides the celiac, that means profile 97 with a celiac clause.
• Excluded: the commando brigade, the paratroopers and the submarine flotilla, because in emergency situations it is not logistically possible to supply suitable food. Reconnaissance units are also closed, with pilot, naval officer and naval combat roles remaining open.
• Open: many field units, in combat and combat-support roles. The source names some of them, and naming them matters more to an anxious teenager than the exclusions do: pilot, naval combatant (boys), recruit-squad commander, and others. Point the teen at the IDF's own celiac page for the fuller list rather than leaving them with a list of closed doors.
• Food stipend: celiac soldiers are entitled to a food stipend for purchasing food, in addition to the nutritional provision in military dining halls. The amount may change from time to time and is affected by the type of service, open base or closed base.

Do not state a shekel figure for the stipend. It is not published as a fixed number, and inventing one would be exactly the failure mode this skill exists to avoid. Point the user at the IDF's own celiac information.

Step 7: Money, honestly

Start by managing expectations. Celiac does not appear as a named qualifying impairment on the Bituach Leumi disabled-child impairment list, which does name allergy. Do not encourage a family to file expecting the allergy outcome. If a child has an additional condition, that is a separate question for the general Bituach Leumi route.

What does exist is municipal, not national:

• Celiac patients up to retirement age who are known to and treated by the social services department, and who purchase medicinal or dedicated food on a physician's recommendation, may be eligible for funding assistance. It is given through the social services department, subject to budget limits and the priorities set in each local authority.
• Celiac patients who have reached retirement age and need special nutrition on a physician's recommendation may likewise be eligible.

Both are discretionary and budget-bound. Frame them as worth applying for, never as guaranteed. The physician's recommendation is the precondition to obtain first.

Examples

Example 1: Parent suspects celiac and has already cut out bread

The highest-stakes case. Explain plainly that removing gluten before diagnosis can mislead the tests and make diagnosis harder, and that the standard pathway involves eating gluten up to the biopsy. Tell them to disclose the dietary change to the doctor at the referral. Do not instruct them to resume gluten themselves. Then outline what testing involves so they know what to expect.

Example 2: Newly diagnosed 6-year-old, school starts in September

Skip the allergy machinery entirely. Draft the education request: substitutes in every activity including trips, a gluten-free offering wherever food is sold, and portions in a different colour with prominent marking. Remind the parents of their own duty to inform the team before the year starts.

Example 3: 17-year-old with celiac worried about the army

Reassure: regular enlistment profile with a celiac clause, profile 97 absent other limitations, many field roles open. Name the specific exclusions honestly. Explain the food stipend exists on top of dining-hall provision, and that the amount varies by open or closed base rather than quoting a number.

Example 4: Family asks whether they get an allowance

Answer honestly that celiac is not a named criterion on the disabled-child impairment list, then pivot to what is real: the municipal welfare funding route via social services with a physician's recommendation, and the medication-alternative right.

Bundled Resources

References

Recommended MCP Servers

Gotchas

These are agent failure modes, not user errors.

1. Do not advise a gluten-free diet before testing. This is the defining mistake in the domain. An agent that responds to "we think it's gluten" with dietary tips instead of "get tested first" has actively harmed the user.
2. Do not tell a user to restart gluten on their own. Once they have already stopped, reintroduction is a medical decision. Route it to the doctor.
3. Do not import the allergy playbook. No EpiPen, no anaphylaxis, no 101 pathway, no Ministry of Education allergen-free-zone circular. Those belong to israeli-food-allergy-navigator.
4. Do not imply a Bituach Leumi allowance. Allergy has a named criterion and celiac does not. Agents generalise from the sibling skill and invent an entitlement.
5. Do not quote an IDF stipend figure. The amount is not published as a fixed number and varies by open or closed base.
6. Do not equate kosher-for-Passover with gluten free, or kitniyot with gluten. Two separate vocabularies, and conflating them puts matza flour on a celiac plate.
7. Do not treat a single negative serology as conclusive without noting the IgA-deficiency caveat.
8. Do not present the birthday-snack shortlist as certification. It is a community list with a compilation date, and recipes and production lines change. Every quote from it must carry the read-the-pack rule. An agent that answers "yes, that product is gluten free" instead of "that product is on a shortlist, check the marking on the pack" has converted a shopping aid into a safety claim it cannot back.
9. Do not generalise a marking from a brand to its whole range. Beigele has a marked gluten-free line sold beside the regular wheat one, which is verified. Petit Beurre and the Kinder eggs are reported by the parents' community to work the same way, but those two pairs are not verified here, so treat them as a pattern to check on the pack rather than as a fact about which box is safe.

Reference Links

Troubleshooting

Problem: "We cut out gluten a month ago and now the doctor wants tests"

Explain that this is common and not a disaster, but that it must be disclosed. A gluten-free diet started before diagnosis can mislead the tests. The doctor decides what happens next, including whether a gluten challenge is needed. Do not design that plan.

Problem: "The school says they cannot guarantee no cross-contamination"

Separate the two asks. The written entitlement is substitutes in every activity, a gluten-free offering wherever food is sold, and portions in a different colour with prominent marking. Request those specifically, in writing, rather than asking for a guarantee the kitchen cannot give.

Problem: "The pharmacy says there is no gluten-free version of the drug"

Two moves. Check whether the drug actually contains wheat-derived flour or starch. If it does and the basket option is unsuitable, raise the right to a suitable alternative with the treating physician and the kupah rather than paying privately.